Processing fundus images using machine learning models

ABSTRACT

Methods, systems, and apparatus, including computer programs encoded on computer storage media, for processing fundus images using fundus image processing machine learning models. One of the methods includes obtaining a model input comprising one or more fundus images, each fundus image being an image of a fundus of an eye of a patient; processing the model input using a fundus image processing machine learning model, wherein the fundus image processing machine learning model is configured to process the model input comprising the one or more fundus image to generate a model output; and processing the model output to generate health analysis data.

BACKGROUND

This specification relates to processing images using a machine learningmodel.

Machine learning models receive an input and generate an output, e.g., apredicted output, based on the received input. Some machine learningmodels are parametric models and generate the output based on thereceived input and on values of the parameters of the model.

Some machine learning models are deep models that employ multiple layersof models to generate an output for a received input. For example, adeep neural network is a deep machine learning model that includes anoutput layer and one or more hidden layers that each apply a non-lineartransformation to a received input to generate an output.

Some neural networks are recurrent neural networks. A recurrent neuralnetwork is a neural network that receives an input sequence andgenerates an output sequence from the input sequence. In particular, arecurrent neural network uses some or all of the internal state of thenetwork after processing a previous input in the input sequence ingenerating an output from the current input in the input sequence.

SUMMARY

This specification generally describes a system that generates healthanalysis data for a patient by processing data that includes one or morefundus images of the patient using a fundus image processing machinelearning model.

Particular embodiments of the subject matter described in thisspecification can be implemented so as to realize one or more of thefollowing advantages. A health analysis system can effectively analyzethe health of a patient using only one or more images of the fundus ofthe patient's eye and minimal or no other patient data. In particular,the health analysis system can effectively analyze the presence or theprobable progression of a specific medical condition using the fundusimages. Instead or in addition, the health analysis system caneffectively predict which treatments or follow-up actions will be mosteffective in treating the medical condition. Instead or in addition, thehealth analysis system can accurately evaluate the risk of the patientfor undesirable health events or accurately evaluate the overall healthof the patient using the fundus images. Instead or in addition, thehealth analysis system can accurately predict values of a set of factorsthat contribute to a risk of a particular set of health events happeningto the patient using the fundus images.

In some implementations, the system can present a user of the systemwith data that explains the basis for the predictions generated by thesystem, i.e., the portions of the fundus image that the machine learningmodel focused on to generate a particular prediction. In so doing, thesystem can allow a medical practitioner or other user to have insightinto the prediction process.

The details of one or more embodiments of the subject matter of thisspecification are set forth in the accompanying drawings and thedescription below. Other features, aspects, and advantages of thesubject matter will become apparent from the description, the drawings,and the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows an example fundus image analysis system.

FIG. 2A is a flow diagram of an example process for generating healthanalysis data.

FIG. 2B shows the processing of an example fundus image by the fundusimage processing machine learning model.

FIG. 3 is a flow diagram of an example process for generating healthanalysis data that is specific to a particular medical condition.

FIG. 4 is a flow diagram of an example process for generating healthanalysis data that identifies patient follow-up actions.

FIG. 5 is a flow diagram of an example process for generating healthanalysis data that predicts the likely progression of a medicalcondition.

FIG. 6 is a flow diagram of an example process for generating healthanalysis data that predicts the proper treatment for a medical conditionfor a given patient.

FIG. 7 is a flow diagram of an example process for generating healthanalysis data that includes a predicted fundus image.

FIG. 8 is a flow diagram of an example process for generating healthanalysis data that predicts the risk of a health event occurring.

FIG. 9 is a flow diagram of an example process for generating healthanalysis data that characterizes the overall health of the patient.

FIG. 10 is a flow diagram of an example process for generating healthanalysis data that includes predicted values for one or more riskfactors.

FIG. 11 is a flow diagram of an example process for generating healthanalysis data that includes data identifying locations in a fundus imagethat were focused on by the machine learning model when generating themodel output.

Like reference numbers and designations in the various drawings indicatelike elements.

DETAILED DESCRIPTION

This specification generally describes a system that can generate healthanalysis data for a patient from an input that includes one or morefundus images of the patient and, optionally, other patient data. Afundus image is a photograph of the fundus of one of the eyes of thepatient. The fundus of an eye is the interior surface of the eyeopposite the lens and includes, among other things, the retina and theoptic disc.

Generally, to generate the health analysis data for a given patient, thesystem processes the one or more fundus images and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a model output for the patient and then generates thehealth analysis data from the model output.

FIG. 1 shows an example fundus image analysis system 100. The fundusimage analysis system 100 is an example of a system implemented ascomputer programs on one or more computers in one or more locations, inwhich the systems, components, and techniques described below can beimplemented.

For a given patient, the fundus image analysis system 100 receivesfundus image data 122 that includes one or more fundus images of thepatient's eye and generates health analysis data 142 that characterizesthe health of the patient.

In some implementations, the fundus image analysis system 100 includesor is in communication with a fundus image capturing system 110 thatgenerates the fundus images and provides them as input fundus image data122 to the fundus image analysis system. In particular, the fundus imagecapturing system 110 includes one or more image capturing devices, e.g.,an image capturing device 120, that are configured to capture images ofthe fundus of a patient. Generally, the image capturing device 120 is aspecialized fundus camera that is configured to capture an appropriatetype of fundus image, e.g., using color fundus photography, stereoscopicphotography, wide field or ultra wide field photography, or scanninglaser ophthalmoscopy (SLO). In some cases, the image capturing system110 includes multiple image capturing devices that capture differenttypes of fundus images.

In other implementations, the fundus image analysis system 100 receivesthe input fundus image data 122 from an external system, e.g., over adata communication network.

The fundus image analysis system 100 processes the input fundus imagedata 122 and, optionally, other data for the given patient using afundus image processing machine learning model 130. The fundus imageprocessing machine learning model 130 is a machine learning model thatis configured to process the input fundus image data 122 and,optionally, other patient data 124 to generate a model output 132 thatcharacterizes the health of the patient.

How many fundus images are in the fundus image data 122, whether thesystem 100 receives other patient data 124 and, if so, the nature of theother patient data 124 that is received, and the makeup of the modeloutput 132 are dependent on the configuration of the fundus imageprocessing machine learning model 130. Fundus image data, exampleconfigurations of the machine learning model 130, and example makeups ofthe model output 132 are described in more detail below with referenceto FIGS. 2-9.

The fundus image analysis system 100 also includes a patient healthanalysis subsystem 140 that receives the model output 132 and generatesthe patient health analysis data 142. Generally, the patient healthanalysis subsystem 140 generates health analysis data that characterizesthe model output in a way that can be presented to a user of the system.The patient health analysis subsystem 140 can then provide the healthanalysis data 142 for presentation to the user in a user interface,e.g., on a user computer of the patient or on a computer of a medicalprofessional, store the health analysis data 142 for future use, orprovide the health analysis data 142 for use for some other immediatepurpose.

In some implementations, the fundus image analysis system 100 receivesrequests for patient health analysis data 142 from remote users of usercomputers over a data communication network. For example, a usercomputer, e.g., a computer on which the fundus image capturing system110 is implemented, may be able to submit a request to the fundus imageanalysis system 100 over the data communication network by providingfundus image data as part of making an Application Programming Interface(API) call to the fundus image analysis system 100. In response to theAPI call, the fundus image analysis system 100 can generate the healthanalysis data 142 and transmit the health analysis data to the usercomputer over the data communication network.

Additionally, in some implementations, the machine learning model 130 isimplemented by one or more computers that are remote from the fundusimage analysis system 100. In these implementations, the fundus imageanalysis system 100 can access the machine learning model 130 by makingan API call over a network that includes the input to the machinelearning model 130 and can receive the model output 132 in response tothe API call.

While the description in this specification generally describes a singlemachine learning model 130 that generates a particular model output, insome cases the system 100 includes or communicates with an ensemble ofmultiple machine learning models for a given kind of model output. Eachmachine learning model 130 generates the same kind of model output, andthe system 100 or another system can combine the model outputs generatedby the ensemble, e.g., by computing a measure of central tendency of themodel outputs. The combined output can then be treated as the modeloutput 132 by the system 100.

FIG. 2A is a flow diagram of an example process 200 for generatinghealth analysis data. For convenience, the process 200 will be describedas being performed by a system of one or more computers located in oneor more locations. For example, a fundus image analysis system, e.g.,the fundus image analysis system 100 of FIG. 1, appropriatelyprogrammed, can perform the process 200.

The system receives input fundus image data and, optionally, otherpatient data (step 202).

Generally, the fundus image data includes one or more fundus images of apatient's eye.

In some implementations, the fundus image data includes a single fundusimage, e.g., an image that captures the current state of the patient'sfundus.

In some other implementations, the fundus image data includes multiplefundus images that capture the current state of the patient's fundus.For example, the fundus image data can include one or more images of thefundus in the patient's left eye and one or more images of the fundus inthe patient's right eye. As another example, the fundus images mayinclude multiple different types of fundus photographs. For example, thefundus images may include two or more of: a color fundus photograph, astereoscopic fundus photograph, a wide field or ultra wide field fundusphotograph, or a scanning laser ophthalmoscopy (SLO) fundus photograph.As yet another example, the fundus images can include multiple imagescaptured using different imaging technology, e.g., optical coherencetomography (OCT) and Heidelberg retinal tomography (HRT).

In yet other implementations, the fundus image data includes a temporalsequence of fundus images that capture how the state of the fundus hasevolved over time. That is, the temporal sequence includes multiplefundus images, with each fundus image having been taken at a differenttime. In some implementations, the fundus images are ordered in thetemporal sequence from least recent to most recent.

The other patient data is data that characterizes the patient's eye,data that generally characterizes the patient, or both. For example, theother patient data can include ocular measurement data, e.g., eyepressures, visual fields, visual acuity, central corneal thickness, andso on, patient demographics, e.g., age, gender, ethnicity, familyhistory, and so on, or both.

The system processes the input fundus image data and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a model output (step 204).

Optionally, prior to processing the fundus image data using the machinelearning model, the system can pre-process the fundus images. Forexample, for a given image, the system can apply any of a variety ofconventional image processing techniques to the image to improve thequality of the output generated by the machine learning model. As anexample, the system may crop, scale, deskew or re-center the image. Asanother example, the system can remove distortion from the image, e.g.,to remove blurring or to re-focus the image, using conventional imageprocessing techniques.

In implementations where the fundus image data includes a single fundusimage, the fundus image processing machine learning model is afeedforward machine learning model that has been configured by beingtrained on appropriately labeled training data to process the fundusimage data and, optionally, the other patient data to generate a modeloutput that characterizes a particular aspect of the patient's health.For example, the fundus image processing machine learning model may be adeep convolutional neural network. An example of a deep convolutionalneural network that can be trained to process a fundus image to generatethe model outputs described in this specification is described inSzegedy, Christian et al. “Going deeper with convolutions.” Proceedingsof the IEEE Conference on Computer Vision and Pattern Recognition, 2015.Other examples of deep convolutional neural networks, includingconvolutional neural networks with residual connections, that can betrained to process a fundus image to generate the model outputsdescribed in this specification are described in Szegedy, Christian, etal. “Inception-v4, Inception-ResNet and the Impact of ResidualConnections on Learning,” available at http://arxiv.org/abs/1602.07261.

In implementations where the fundus image data includes multiple fundusimages that characterize the current state of the patient's fundus, thefundus image processing machine learning model may be a feedforwardfundus image processing machine learning model that has been configuredby being trained on appropriately labeled training data to process allof the fundus images to generate a model output that characterizes aparticular aspect of the patient's health. For example, the fundus imageprocessing machine learning model may be a deep convolutional neuralnetwork that includes multiple towers of convolutional layers. Anexample of a deep convolutional neural network that can be trained toprocess multiple fundus images to generate the model outputs describedin this specification is described in Yue-Hei Ng, Joe, et al. “Beyondshort snippets: Deep networks for video classification,” Proceedings ofthe IEEE Conference on Computer Vision and Pattern Recognition, 2015.

In implementations where the fundus image data includes a temporalsequence of fundus images, the fundus image processing machine learningmodel may be a recurrent fundus image processing machine learning modelthat has been configured to process each image in the temporal sequenceone by one to, for each image, update the internal state of therecurrent fundus image processing machine learning model, and to, afterthe last image in the temporal sequence has been processed, generate amodel output that characterizes a particular aspect of the patient'shealth. For example, the fundus image processing machine learning modelmay be a recurrent neural network that includes one or more longshort-term memory (LSTM) layers. A recurrent neural network that can betrained to process a sequence of fundus images to generate the modeloutputs described in this specification is described in Venugopalan,Subhashini, et al. “Sequence to sequence-video to text.” Proceedings ofthe IEEE International Conference on Computer Vision, 2015.

In some implementations, the model output is specific to a particularmedical condition. Model outputs that are specific to a particularmedical condition are described in more detail below with reference toFIGS. 3-6.

In some other implementations, the model output is a prediction of afuture state of the fundus of the patient's eye. A model output that isa prediction of the future state of a fundus is described in more detailbelow with reference to FIG. 7.

In yet other implementations, the model output is a prediction of therisk of a particular health event occurring in the future. A modeloutput that is a prediction of the risk of a particular event occurringis described in more detail below with reference to FIG. 8.

In yet other implementations, the model output characterizes the overallhealth of the patient. A model output that characterizes the overallhealth of the patient is described in more detail below with referenceto FIG. 9.

In yet other implementations, the model output is a prediction of valuesof factors that contribute to a particular kind of health-related risk.A model output that is a prediction of values of risk factors isdescribed in more detail below with reference to FIG. 10.

The system generates health analysis data from the model output (step206). Generally, the health analysis data characterizes the model outputin a way that can be presented to a user of the system.

In some implementations, the health analysis data also includes dataderived from an intermediate output of the machine learning model thatexplains the portions of the fundus image or images that the machinelearning model focused on when generating the model output. Inparticular, in some implementations, the machine learning model includesan attention mechanism that assigns respective attention weights to eachof multiple regions of an input fundus image and then attends tofeatures extracted from those regions in accordance with the attentionweights. In these implementations, the system can generate data thatidentifies the attention weights and include the generated data as partof the health analysis data. For example, the generated data can be anattention map of the fundus image that reflects the attention weightsassigned to the regions of the image. For example, the attention map canbe overlaid over the fundus image to identify the areas of the patient'sfundus that the machine learning model focused on when generating themodel output. Generating data that identifies areas of the fundus thatwere focused on by the machine learning model is described in moredetail below with reference to FIG. 11.

The system can then provide the health analysis data for presentation tothe user in a user interface, e.g., on a user computer of the patient oron a computer of a medical professional, or store the health analysisdata for future use.

FIG. 2B shows the processing of an example fundus image 150 by thefundus image processing machine learning model 130. In particular, inthe example of FIG. 1B, the fundus image processing machine learningmodel 130 is a deep convolutional neural network that is configured toreceive the fundus image 150 and to process the fundus image 150 togenerate a model output that characterizes a particular aspect of thepatient's health.

The convolutional neural network illustrated in FIG. 2B is a simplifiedexample of a deep convolutional neural network and includes a set ofconvolutional neural network layers 162, followed by a set of fullyconnected layers 164, and an output layer 166. It will be understoodthat, in practice, a deep convolutional neural network may include othertypes of neural network layers, e.g., pooling layers, normalizationlayers, and so on, and may be arranged in various configurations, e.g.,as multiple modules, multiple subnetworks, and so on.

During the processing of the fundus image 150 by the convolutionalneural network, the output layer 166 receives an output generated by thelast fully connected layer in the set of fully connected layers 164 andgenerates the model output for the fundus image 150. In the example ofFIG. 2B, the model output is a set of scores 170, with each score beinggenerated by a corresponding node in the output layer 166. As will bedescribed in more detail below, in some cases, the set of scores 170 arespecific to particular medical condition. In some other cases, the eachscore in the set of scores 170 is a prediction of the risk of arespective health event occurring in the future. In yet other cases, thescores in the set of scores 170 characterize the overall health of thepatient.

Once the set of scores 170 have been generated, the fundus imageanalysis system generates patient health analysis data thatcharacterizes an aspect of the patient's health from the scores 170 andprovides the health analysis data for presentation to the user in a userinterface, e.g., on a user computer of the patient or on a computer of amedical professional, stores the health analysis data for future use, orprovides the health analysis data for use for some other immediatepurpose.

FIG. 3 is a flow diagram of an example process 300 for generating healthanalysis data that is specific to a particular medical condition. Forconvenience, the process 300 will be described as being performed by asystem of one or more computers located in one or more locations. Forexample, a fundus image analysis system, e.g., the fundus image analysissystem 100 of FIG. 1, appropriately programmed, can perform the process300.

The system receives input fundus image data and, optionally, otherpatient data (step 302).

The system processes the input fundus image data and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a set of condition state scores (step 304).

Generally, the set of condition state scores are specific to aparticular medical condition that the system has been configured toanalyze.

In some implementations, the medical condition is a particulareye-related condition.

For example, the particular eye-related condition may be glaucoma.Generally, glaucoma is a condition in which the optic nerve is damaged,which can result in blindness.

As another example, the particular eye-related condition may beage-related macular degeneration. Generally, age-related maculardegeneration is a condition in which the macula, an area near the centerof the retina, has deteriorated, which may cause partial or total visionloss.

As another example, the particular eye-related condition may be retinaldetachment. Generally, retinal detachment is a disorder in which theretina detaches either partially or completely from its underlying layerof support tissue.

As yet another example, the particular eye-related condition may beocular occlusions. Generally, an ocular occlusion is the blockage orclosing of a blood vessel that carries blood to or from some portion ofthe eye, e.g., to or from the retina.

In some other implementations, the specific condition is not aneye-related condition but is instead a neurodegenerative condition,e.g., Parkinson's or Alzheimer's, or another condition that caneffectively be analyzed using fundus imagery.

In some implementations, the set of condition state scores includes asingle score that represents a likelihood that the patient has themedical condition.

For example, in the case of glaucoma, the single score may represent alikelihood that the patient has glaucoma.

As another example, in the case of age-related macular degeneration, thesingle score may represent a likelihood that the patient has age-relatedmacular degeneration.

As another example, in the case of retinal detachment, the single scoremay represent a likelihood that the patient has retinal detachment.

As another example, in the case of ocular occlusions, the single scoremay represent a likelihood that the patient has one or more ocularocclusions.

As another example, in the case of neurodegenerative conditions, thesingle score may represent a likelihood that the patient has theneurodegenerative condition e.g., Parkinson's or Alzheimer's.

In some other implementations, the set of condition state scoresincludes a respective score for each of multiple possible levels of themedical condition, with each condition score representing a likelihoodthat the corresponding level is current level of the condition for thepatient.

For example, in the case of glaucoma, the set of scores may include ascore for no glaucoma, mild or early-stage glaucoma, moderate-stageglaucoma, severe-stage glaucoma, and, optionally, an indeterminate orunspecified stage.

As another example, in the case of age-related macular degeneration, theset of scores may include a score for no macular degeneration,early-stage macular degeneration, intermediate macular degeneration,advanced macular degeneration, and, optionally, an indeterminate orunspecified stage.

As another example, in the case of retinal detachment, the set of scoresmay include a score for no retinal detachment, initial retinaldetachment, i.e., only retinal tears or retinal breaks, advanced retinaldetachment, and, optionally, an indeterminate or unspecified stage.

As another example, in the case of ocular occlusions, the set of scoresmay include a score for no ocular occlusions, minor ocular occlusions,severe ocular occlusions, and, optionally, an indeterminate orunspecified stage.

As another example, in the case of neurodegenerative conditions, the setof scores may include a score for not having the neurodegenerativecondition, a score for each of multiple stages of the neurodegenerativecondition, and, optionally, an indeterminate or unspecified stage.

The system generates health analysis data from the condition statescores (step 306). For example, the system can generate health analysisdata that identifies the likelihood that the patient has the medicalcondition or identifies one or more condition levels that have thehighest condition state scores.

FIG. 4 is a flow diagram of an example process 400 for generating healthanalysis data that identifies patient follow-up actions. Forconvenience, the process 400 will be described as being performed by asystem of one or more computers located in one or more locations. Forexample, a fundus image analysis system, e.g., the fundus image analysissystem 100 of FIG. 1, appropriately programmed, can perform the process400.

The system receives input fundus image data and, optionally, otherpatient data (step 402).

The system processes the input fundus image data and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a set of follow-up scores (step 404).

The set of follow-up scores includes a respective score for each ofmultiple possible follow-up actions that can be taken by the patient totreat a particular medical condition. For example, the set of possiblefollow-up actions may include performing a re-screening at a futuretime, visiting a doctor at a future time, and visiting a doctorimmediately. Each follow-up score represents a likelihood that thecorresponding follow-up action is the proper action to be taken toeffectively treat the medical condition.

The system generates health analysis data from the follow-up scores(step 406). For example, the system can generate health analysis datathat recommends that the patient take the follow-up action that has thehighest follow-up score.

FIG. 5 is a flow diagram of an example process 500 for generating healthanalysis data that predicts the likely progression of a medicalcondition. For convenience, the process 500 will be described as beingperformed by a system of one or more computers located in one or morelocations. For example, a fundus image analysis system, e.g., the fundusimage analysis system 100 of FIG. 1, appropriately programmed, canperform the process 500.

The system receives input fundus image data and, optionally, otherpatient data (step 502).

The system processes the input fundus image data and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a set of progression scores (step 504). The set ofprogression scores are specific to a particular medical condition thatthe system has been configured to analyze. The set of condition statescores includes a respective score for each of multiple possible levelsof the medical condition, with each condition score representing alikelihood that the corresponding level will be the level of thecondition for the patient at a predetermined future time, e.g., in 6months, in 1 year, or in 5 years.

For example, in the case of glaucoma, the set of scores may include ascore for no glaucoma, mild or early-stage glaucoma, moderate-stageglaucoma, and severe-stage glaucoma, with the score for each stagerepresenting the likelihood that the corresponding stage will be thestage of glaucoma for the patient at the future time.

As another example, in the case of age-related macular degeneration, theset of scores may include a score for no macular degeneration,early-stage macular degeneration, intermediate-stage maculardegeneration, and advanced-stage macular degeneration, and, optionally,with the score for each stage representing the likelihood that thecorresponding stage will be the stage of macular degeneration for thepatient at the future time.

As another example, in the case of neurodegenerative conditions, the setof scores may include a score for not having the neurodegenerativecondition and a score for each of multiple stages of theneurodegenerative condition, with the score for each stage representingthe likelihood that the corresponding stage will be the stage of thecondition for the patient at the future time.

The system generates health analysis data from the progression scores(step 506). The health analysis data identifies the likely progressionof the medical condition for the patient. For example, the system cangenerate health analysis data that identifies one or more of thepossible condition levels and, for each possible condition level, thelikelihood that the corresponding level will be the future level of thecondition for the patient.

FIG. 6 is a flow diagram of an example process 600 for generating healthanalysis data that predicts the proper treatment for a medical conditionfor a given patient. For convenience, the process 600 will be describedas being performed by a system of one or more computers located in oneor more locations. For example, a fundus image analysis system, e.g.,the fundus image analysis system 100 of FIG. 1, appropriatelyprogrammed, can perform the process 600.

The system receives input fundus image data and, optionally, otherpatient data (step 602).

The system processes the input fundus image data and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a set of treatment scores (step 604).

The set of treatment scores include a respective score for each ofmultiple possible treatments for a given medical condition, with eachtreatment score representing a likelihood that the correspondingtreatment is the most effective treatment for the condition for thecurrent patient.

For example, the set of treatment scores can include a respective scorefor each of multiple medications that can be prescribed to a patientthat has the medical condition.

As another example, the set of treatment scores can include a respectivescore for each of multiple treatment plans for a given medicalcondition, e.g., a respective score for one or more medical proceduresand a score for rehabilitation without undergoing a procedure.

The system generates health analysis data from the progression scores(step 606). For example, the health analysis data can identify one ormore of the highest-scoring treatments.

FIG. 7 is a flow diagram of an example process 700 for generating healthanalysis data that includes a predicted fundus image. For convenience,the process 700 will be described as being performed by a system of oneor more computers located in one or more locations. For example, afundus image analysis system, e.g., the fundus image analysis system 100of FIG. 1, appropriately programmed, can perform the process 700.

The system receives input fundus image data and, optionally, otherpatient data (step 702).

The system processes the input fundus image data and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a predicted fundus image (step 704).

The predicted fundus image is an image of the fundus of the eye of thepatient as it is predicted to look at a particular future time, e.g., insix months, in one year, or in five years.

For example, the fundus image processing machine learning model may be aconvolutional neural network that is configured through training topredict, for each pixel in the input fundus image, the color of thepixel at the particular future time.

As another example, when the fundus image data includes a temporalsequence of fundus images, the fundus image processing machine learningmodel may be a recurrent neural network that is configured throughtraining to, for each pixel in the most recent fundus image in thesequence, predict the color of the pixel at the particular future time.The system can use the predicted color values for the pixels to generatethe predicted fundus image.

The system generates health analysis data from the progression scores(step 706). For example, the health analysis data can include thepredicted fundus image and, optionally, additional health analysis data.

FIG. 8 is a flow diagram of an example process 800 for generating healthanalysis data that predicts the risk of a health event occurring. Forconvenience, the process 800 will be described as being performed by asystem of one or more computers located in one or more locations. Forexample, a fundus image analysis system, e.g., the fundus image analysissystem 100 of FIG. 1, appropriately programmed, can perform the process800.

The system receives input fundus image data and, optionally, otherpatient data (step 802).

The system processes the input fundus image data and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a set of risk scores (step 804).

In some implementations, the set of risk scores includes a single scorethat measures a particular kind of risk. For example, the score maymeasure a predicted cardiovascular risk of the patient, e.g., may be apredicted Framingham risk score that measures the 10-year cardiovascularrisk of the patient.

In some other implementations, the set of risk scores may be specific toa particular undesirable health event.

For example, the undesirable health event may be a heart attack, astroke, mortality, hospitalization, a fall, complications pre-operationor post-operation, and so on. In some of these implementations, the setof risk scores includes a single score that represents a likelihood ofthe undesirable health event occurring in the future, e.g., within aspecified future time window. In others of these implementations, theset of risk scores includes a respective score for each of multiple risklevels, e.g., low, medium, and high, for the health event, with eachrisk score representing a likelihood that the corresponding risk levelis the current risk level of the health event occurring.

In yet other implementations, the set of scores can include multiplescores, with each score corresponding to a respective undesirable healthevent and representing a likelihood that the corresponding undesirablehealth event will occur in the future, e.g., within a specified futuretime window.

The system generates health analysis data from the risk scores (step806). For example, in implementations where the set of scores includes asingle score, the health analysis data can identify the single score. Asanother example, where the set of scores includes multiple scores, thehealth analysis data can identify the highest-scoring risk level.

FIG. 9 is a flow diagram of an example process 900 for generating healthanalysis data that characterizes the overall health of the patient. Forconvenience, the process 900 will be described as being performed by asystem of one or more computers located in one or more locations. Forexample, a fundus image analysis system, e.g., the fundus image analysissystem 100 of FIG. 1, appropriately programmed, can perform the process900.

The system receives input fundus image data and, optionally, otherpatient data (step 902).

The system processes the input fundus image data and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a set of wellness scores (step 904).

In some implementations, the set of wellness scores includes a singlescore that measures the overall health of the patient on a predeterminedscale.

In some other implementations, the set of wellness scores may include arespective score for each of multiple wellness labels that eachcharacterize the overall health of the patient. For example, thewellness labels may be “very healthy,” “healthy,” “somewhat unhealthy,”and “very unhealthy.” Each score represents a likelihood that thecorresponding wellness label accurately characterizes the current healthof the patient. Thus, for example the score for the wellness label “veryhealthy” represents the likelihood that the patient is very healthy,while the score for the “somewhat unhealthy” label represents thelikelihood that the patient is somewhat unhealthy.

The system generates health analysis data from the risk scores (step906). For example, in implementations where the set of scores includes asingle score, the health analysis data can identify the single score. Asanother example, where the set of scores includes multiple scores, thehealth analysis data can identify the highest-scoring wellness label.

FIG. 10 is a flow diagram of an example process 1000 for generatinghealth analysis data that includes predicted values for one or more riskfactors. For convenience, the process 1000 will be described as beingperformed by a system of one or more computers located in one or morelocations. For example, a fundus image analysis system, e.g., the fundusimage analysis system 100 of FIG. 1, appropriately programmed, canperform the process 1000.

The system receives input fundus image data that includes one or morefundus images (step 1002).

The system processes the input fundus image data using a fundus imageprocessing machine learning model to generate a respective predictedvalue for each of one or more risk factors (step 1004).

Each of the risk factors is a factor that contributes to the risk of oneof a particular set of health-related events happening to the patient.For example, when the risk is cardiovascular risk, the particular set ofhealth-related events can be a health event that is classified as amajor cardiovascular health event, e.g., myocardial infarction, heartfailure, percutaneous cardiac intervention, coronary artery bypassgrafting, malignant dysrhythmia, cardiac shock, implantable cardiacdefibrillator, malignant dysrhythmia, cardiac-related mortality, and soon.

Continuing the example of cardiovascular risk, the risk factors caninclude one or more of: age, gender, body mass index, systolic bloodpressure, diastolic blood pressure, a measure of HbA1c (glycatedhemoglobin), or smoking status, i.e., whether or not the patient smokescigarettes.

In some implementations, the system employs multiple machine learningmodels that each generate a predicted value for a different subset ofthe risk factors. For example, one model may generate predicted valuesfor binary risk factors that can only take one of two values, e.g.,smoking status and gender, while another model may generate predictedvalues for continuous risk factors that can take continuous values fromsome value range, e.g., age, body mass index, and blood pressure. Eachof the two models may have similar architectures, but with differentparameter values.

The system generates health analysis data from the predicted values(step 1006). For example, the health analysis data can identify eachgenerated predicted value. In some cases, the system can use thepredicted values to compute a measure of the particular risk and providethe computed measure of risk as part of the health analysis data. Forexample, the system can provide the predicted values as input to anothermachine learning model configured to predict the measure of risk or to ahard-coded formula to obtain the computed measure. For example, in thecase of cardiovascular risk, the system can compute a Framingham riskscore using the predicted values. Alternatively, the system can providethe predicted values as input to a machine learning model that has beentrained to predict a risk measure based on values of risk factors.

FIG. 11 is a flow diagram of an example process 1100 for generatinghealth analysis data that includes data identifying locations in afundus image that were focused on by the machine learning model whengenerating the model output. For convenience, the process 1100 will bedescribed as being performed by a system of one or more computerslocated in one or more locations. For example, a fundus image analysissystem, e.g., the fundus image analysis system 100 of FIG. 1,appropriately programmed, can perform the process 1100.

The system receives input fundus image data and, optionally, otherpatient data (step 1102).

The system processes the input fundus image data and, optionally, theother patient data using a fundus image processing machine learningmodel to generate a model output (step 1104). The model output can beany of the model outputs described above with reference to FIGS. 2-10.

In particular, the machine leaning model is a model that includes one ormore initial convolutional layers followed by an attention mechanism,which in turn is followed by one or more additional neural networklayers.

The initial convolutional layers process each fundus image in the fundusimage data to extract a respective feature vector for each of multipleregions in the fundus image.

The attention mechanism determines an attention weight for each of theregions in the fundus image and then attends to the feature vectors inaccordance with the corresponding attention weights to generate anattention output. Generally, the attention mechanism attends to thefeature vectors by computing a weighted sum or a weighted mean of thefeature vectors, with the weight for each feature vector being theattention weight for the corresponding region. To determine theattention weights, the system can use any of a variety of attentionschemes to determine the relevance of each of the feature vectors togenerating the model output for the fundus image and then normalize thedetermined relevances to compute the attention weights. Exampleattention schemes include processing the feature vectors using one ormore fully-connected layers to determine the relevance and determiningthe relevance of a given feature vector by computing a cosine similaritybetween the feature vector and a learned context vector. An exampleattention mechanism that can be adapted for use in the fundus imageprocessing machine learning model is described in “Show, Attend andTell: Neural Image Caption Generation with Visual Attention,” Xu et al,available at https://arxiv.org/abs/1502.03044.

The additional neural network layers that follow the attention mechanismreceive the attention output(s) for each of the fundus images andgenerate the model output from the attention output. For example, whenthe machine learning model is a recurrent neural network, the additionalneural network layers include one or more recurrent layers. When themachine learning model is a convolutional neural network, the additionalneural network layers can include convolutional neural network layers,fully-connected layers or other conventional feedforward neural networklayers.

The system generates health analysis data from the risk scores (step1106). In particular, as described above, the health analysis datacharacterizes the model output in a way that can be presented to a userof the system.

In addition, the health analysis data includes data characterizing theareas of the fundus image that the machine learning model focused on togenerate the model output. In particular, the health analysis datainclude data identifying the attention weights assigned to the regionsin the fundus image. For example, the system can generate an attentionmap that identifies, for each pixel in the fundus image, the attentionweight assigned to the pixel, i.e., the attention weight for the regionof the image that the pixel belongs to. For example, the attention mapcan be a heat map that represents the attention weights as colors. Insome implementations, the system provides the attention map as anoverlay of the corresponding fundus image.

This specification uses the term “configured” in connection with systemsand computer program components. For a system of one or more computersto be configured to perform particular operations or actions means thatthe system has installed on it software, firmware, hardware, or acombination of them that in operation cause the system to perform theoperations or actions. For one or more computer programs to beconfigured to perform particular operations or actions means that theone or more programs include instructions that, when executed by dataprocessing apparatus, cause the apparatus to perform the operations oractions.

Embodiments of the subject matter and the functional operationsdescribed in this specification can be implemented in digital electroniccircuitry, in tangibly-embodied computer software or firmware, incomputer hardware, including the structures disclosed in thisspecification and their structural equivalents, or in combinations ofone or more of them. Embodiments of the subject matter described in thisspecification can be implemented as one or more computer programs, i.e.,one or more modules of computer program instructions encoded on atangible non transitory storage medium for execution by, or to controlthe operation of, data processing apparatus. The computer storage mediumcan be a machine-readable storage device, a machine-readable storagesubstrate, a random or serial access memory device, or a combination ofone or more of them. Alternatively or in addition, the programinstructions can be encoded on an artificially generated propagatedsignal, e.g., a machine-generated electrical, optical, orelectromagnetic signal, that is generated to encode information fortransmission to suitable receiver apparatus for execution by a dataprocessing apparatus.

The term “data processing apparatus” refers to data processing hardwareand encompasses all kinds of apparatus, devices, and machines forprocessing data, including by way of example a programmable processor, acomputer, or multiple processors or computers. The apparatus can alsobe, or further include, special purpose logic circuitry, e.g., an FPGA(field programmable gate array) or an ASIC (application specificintegrated circuit). The apparatus can optionally include, in additionto hardware, code that creates an execution environment for computerprograms, e.g., code that constitutes processor firmware, a protocolstack, a database management system, an operating system, or acombination of one or more of them.

A computer program, which may also be referred to or described as aprogram, software, a software application, an app, a module, a softwaremodule, a script, or code, can be written in any form of programminglanguage, including compiled or interpreted languages, or declarative orprocedural languages; and it can be deployed in any form, including as astand alone program or as a module, component, subroutine, or other unitsuitable for use in a computing environment. A program may, but neednot, correspond to a file in a file system. A program can be stored in aportion of a file that holds other programs or data, e.g., one or morescripts stored in a markup language document, in a single file dedicatedto the program in question, or in multiple coordinated files, e.g.,files that store one or more modules, sub programs, or portions of code.A computer program can be deployed to be executed on one computer or onmultiple computers that are located at one site or distributed acrossmultiple sites and interconnected by a data communication network.

In this specification, the term “database” is used broadly to refer toany collection of data: the data does not need to be structured in anyparticular way, or structured at all, and it can be stored on storagedevices in one or more locations. Thus, for example, the index databasecan include multiple collections of data, each of which may be organizedand accessed differently.

Similarly, in this specification the term “engine” is used broadly torefer to a software-based system, subsystem, or process that isprogrammed to perform one or more specific functions. Generally, anengine will be implemented as one or more software modules orcomponents, installed on one or more computers in one or more locations.In some cases, one or more computers will be dedicated to a particularengine; in other cases, multiple engines can be installed and running onthe same computer or computers.

The processes and logic flows described in this specification can beperformed by one or more programmable computers executing one or morecomputer programs to perform functions by operating on input data andgenerating output. The processes and logic flows can also be performedby special purpose logic circuitry, e.g., an FPGA or an ASIC, or by acombination of special purpose logic circuitry and one or moreprogrammed computers.

Computers suitable for the execution of a computer program can be basedon general or special purpose microprocessors or both, or any other kindof central processing unit. Generally, a central processing unit willreceive instructions and data from a read only memory or a random accessmemory or both. The essential elements of a computer are a centralprocessing unit for performing or executing instructions and one or morememory devices for storing instructions and data. The central processingunit and the memory can be supplemented by, or incorporated in, specialpurpose logic circuitry. Generally, a computer will also include, or beoperatively coupled to receive data from or transfer data to, or both,one or more mass storage devices for storing data, e.g., magnetic,magneto optical disks, or optical disks. However, a computer need nothave such devices. Moreover, a computer can be embedded in anotherdevice, e.g., a mobile telephone, a personal digital assistant (PDA), amobile audio or video player, a game console, a Global PositioningSystem (GPS) receiver, or a portable storage device, e.g., a universalserial bus (USB) flash drive, to name just a few.

Computer readable media suitable for storing computer programinstructions and data include all forms of non volatile memory, mediaand memory devices, including by way of example semiconductor memorydevices, e.g., EPROM, EEPROM, and flash memory devices; magnetic disks,e.g., internal hard disks or removable disks; magneto optical disks; andCD ROM and DVD-ROM disks.

To provide for interaction with a user, embodiments of the subjectmatter described in this specification can be implemented on a computerhaving a display device, e.g., a CRT (cathode ray tube) or LCD (liquidcrystal display) monitor, for displaying information to the user and akeyboard and a pointing device, e.g., a mouse or a trackball, by whichthe user can provide input to the computer. Other kinds of devices canbe used to provide for interaction with a user as well; for example,feedback provided to the user can be any form of sensory feedback, e.g.,visual feedback, auditory feedback, or tactile feedback; and input fromthe user can be received in any form, including acoustic, speech, ortactile input. In addition, a computer can interact with a user bysending documents to and receiving documents from a device that is usedby the user; for example, by sending web pages to a web browser on auser's device in response to requests received from the web browser.Also, a computer can interact with a user by sending text messages orother forms of message to a personal device, e.g., a smartphone that isrunning a messaging application, and receiving responsive messages fromthe user in return.

Data processing apparatus for implementing machine learning models canalso include, for example, special-purpose hardware accelerator unitsfor processing common and compute-intensive parts of machine learningtraining or production, i.e., inference, workloads.

Machine learning models can be implemented and deployed using a machinelearning framework, e.g., a TensorFlow framework, a Microsoft CognitiveToolkit framework, an Apache Singa framework, or an Apache MXNetframework.

Embodiments of the subject matter described in this specification can beimplemented in a computing system that includes a back end component,e.g., as a data server, or that includes a middleware component, e.g.,an application server, or that includes a front end component, e.g., aclient computer having a graphical user interface, a web browser, or anapp through which a user can interact with an implementation of thesubject matter described in this specification, or any combination ofone or more such back end, middleware, or front end components. Thecomponents of the system can be interconnected by any form or medium ofdigital data communication, e.g., a communication network. Examples ofcommunication networks include a local area network (LAN) and a widearea network (WAN), e.g., the Internet.

The computing system can include clients and servers. A client andserver are generally remote from each other and typically interactthrough a communication network. The relationship of client and serverarises by virtue of computer programs running on the respectivecomputers and having a client-server relationship to each other. In someembodiments, a server transmits data, e.g., an HTML page, to a userdevice, e.g., for purposes of displaying data to and receiving userinput from a user interacting with the device, which acts as a client.Data generated at the user device, e.g., a result of the userinteraction, can be received at the server from the device.

While this specification contains many specific implementation details,these should not be construed as limitations on the scope of anyinvention or on the scope of what may be claimed, but rather asdescriptions of features that may be specific to particular embodimentsof particular inventions. Certain features that are described in thisspecification in the context of separate embodiments can also beimplemented in combination in a single embodiment. Conversely, variousfeatures that are described in the context of a single embodiment canalso be implemented in multiple embodiments separately or in anysuitable subcombination. Moreover, although features may be describedabove as acting in certain combinations and even initially be claimed assuch, one or more features from a claimed combination can in some casesbe excised from the combination, and the claimed combination may bedirected to a subcombination or variation of a subcombination.

Similarly, while operations are depicted in the drawings and recited inthe claims in a particular order, this should not be understood asrequiring that such operations be performed in the particular ordershown or in sequential order, or that all illustrated operations beperformed, to achieve desirable results. In certain circumstances,multitasking and parallel processing may be advantageous. Moreover, theseparation of various system modules and components in the embodimentsdescribed above should not be understood as requiring such separation inall embodiments, and it should be understood that the described programcomponents and systems can generally be integrated together in a singlesoftware product or packaged into multiple software products.

Particular embodiments of the subject matter have been described. Otherembodiments are within the scope of the following claims. For example,the actions recited in the claims can be performed in a different orderand still achieve desirable results. As one example, the processesdepicted in the accompanying figures do not necessarily require theparticular order shown, or sequential order, to achieve desirableresults. In some cases, multitasking and parallel processing may beadvantageous.

1-111. (canceled)
 112. A method comprising: obtaining a model inputcomprising one or more fundus images, each fundus image being an imageof a fundus of an eye of a patient; processing the model input using afundus image processing machine learning model, wherein the fundus imageprocessing machine learning model is configured to process the modelinput comprising the one or more fundus images to generate a modeloutput that characterizes the health of the patient with respect toglaucoma; and processing the model output to generate health analysisdata that analyzes an aspect of the health of the patient with respectto glaucoma.
 113. The method of claim 112, wherein the model inputfurther comprises other patient data comprising ocular measurement data,patient demographic data, or both.
 114. The method of claim 112, whereinthe fundus image processing machine learning model is a feedforwardmachine learning model, and wherein the one or more fundus imagescomprise a single fundus image that captures a current state of thefundus of the eye of the patient.
 115. The method of claim 112, whereinthe fundus image processing machine learning model is a feedforwardmachine learning model, and wherein the one or more fundus imagescomprise a plurality of fundus images that each capture a differentaspect of a current state of the fundus of the eye of the patient. 116.The method of claim 112 wherein the fundus image processing machinelearning model is a recurrent machine learning model, and wherein theone or more fundus images comprise a temporal sequence of a plurality offundus images that capture how the fundus of the patient has evolvedover time.
 117. The method of claim 112, wherein the model outputcomprises a condition state score that represents a likelihood that thepatient has glaucoma.
 118. The method of claim 112, wherein the modeloutput comprises a plurality of condition state scores, each conditionstate score corresponding to a respective possible level of glaucoma andeach condition state score representing a respective likelihood that thecorresponding possible level of glaucoma is a current level of glaucomafor the patient.
 119. The method of claim 112, wherein the model outputcomprises a plurality of follow-up scores, each follow-up scorecorresponding to a respective possible follow-up action that can betaken by the patient to treat the glaucoma and each follow-up scorerepresenting a respective likelihood that the corresponding follow-upaction is the proper action to be taken to effectively treat theglaucoma.
 120. The method of claim 112, wherein the model outputcomprises a plurality of progression scores, each progression scorecorresponding to a respective possible level of the glaucoma, and eachcondition score representing a respective likelihood that thecorresponding level will be the level of the glaucoma for the patient ata predetermined future time.
 121. The method of claim 112, wherein thefundus image processing machine learning model system comprises anensemble of machine learning models.
 122. The method of claim 112,wherein the fundus image processing machine learning model comprises anattention mechanism that is configured to: receive a respective featurevector for each of a plurality of regions in the fundus image generatedby one or more initial layers of the fundus image processing machinelearning model, compute a respective attention weight for each of theregions, and generate an attention output by attending to the featurevectors in accordance with the attention weights for the regions infundus image; and wherein the health analysis data comprises dataidentifying the attention weights generated by the attention mechanism.123. The method of claim 122, wherein the data identifying the attentionweights is an attention map that specifies the attention weights for theregions in the fundus image.
 124. A system comprising one or morecomputers and one or more storage devices storing instructions that whenexecuted by the one or more computers cause the one or more computers toperform operations comprising: obtaining a model input comprising one ormore fundus images, each fundus image being an image of a fundus of aneye of a patient; processing the model input using a fundus imageprocessing machine learning model, wherein the fundus image processingmachine learning model is configured to process the model inputcomprising the one or more fundus images to generate a model output thatcharacterizes the health of the patient with respect to glaucoma; andprocessing the model output to generate health analysis data thatanalyzes an aspect of the health of the patient with respect toglaucoma.
 125. The system of claim 124, wherein the model outputcomprises a condition state score that represents a likelihood that thepatient has glaucoma.
 126. The system of claim 124, wherein the modeloutput comprises a plurality of condition state scores, each conditionstate score corresponding to a respective possible level of glaucoma andeach condition state score representing a respective likelihood that thecorresponding possible level of glaucoma is a current level of glaucomafor the patient.
 127. The system of claim 124, wherein the model outputcomprises a plurality of follow-up scores, each follow-up scorecorresponding to a respective possible follow-up action that can betaken by the patient to treat the glaucoma and each follow-up scorerepresenting a respective likelihood that the corresponding follow-upaction is the proper action to be taken to effectively treat theglaucoma.
 128. One or more non-transitory computer-readable storagemedia encoded with instructions that when executed by one or morecomputers cause the one or more computers to perform to performoperations comprising: obtaining a model input comprising one or morefundus images, each fundus image being an image of a fundus of an eye ofa patient; processing the model input using a fundus image processingmachine learning model, wherein the fundus image processing machinelearning model is configured to process the model input comprising theone or more fundus images to generate a model output that characterizesthe health of the patient with respect to glaucoma; and processing themodel output to generate health analysis data that analyzes an aspect ofthe health of the patient with respect to glaucoma.
 129. Thecomputer-readable storage media of claim 128, wherein the model outputcomprises a condition state score that represents a likelihood that thepatient has glaucoma.
 130. The computer-readable storage media of claim128, wherein the model output comprises a plurality of condition statescores, each condition state score corresponding to a respectivepossible level of glaucoma and each condition state score representing arespective likelihood that the corresponding possible level of glaucomais a current level of glaucoma for the patient.
 131. Thecomputer-readable storage media of claim 128, wherein the model outputcomprises a plurality of follow-up scores, each follow-up scorecorresponding to a respective possible follow-up action that can betaken by the patient to treat the glaucoma and each follow-up scorerepresenting a respective likelihood that the corresponding follow-upaction is the proper action to be taken to effectively treat theglaucoma.